Generalized immersion hypothermia aboard the rescue vessel - раздел Философия, АНГЛИЙСКИЙ ЯЗЫК At Environmental Temperatures Of Less Than 20-21 °C, Man's Survival Depends U...
At environmental temperatures of less than 20-21 °C, man's survival depends upon insulation (body fat, clothing), the ratio of body surface to volume, the basal metabolic rate, and the will to survive.
Seawater freezes at -2°C. It may be assumed that most polar water with ice is as cold as this. In polar water, the body temperature falls very rapidly. Consciousness lasts 5-7 minutes, the ungloved hand is useless in 1-5 minutes, and death occurs in 10-20 minutes. It has been found that severe exposure of the head and neck to cold can cause massive cerebral haemorrhage. These parts of the body should be specially protected.
The rectal temperature should be taken in people rescued from cold water. This can help in estimating the chances of survival in each individual case.
When the rectal temperature is below 35 °C, hypothermia progressively lowers the basal metabolic rate, heart rate, and blood pressure and produces uncontrollable shivering. Hallucinations, apathy, and stupor or unconsciousness occur at 27-30 °C; and death from ventricular fibrillation or cardiac arrest at 21-28 ºC.
Treatment
The treatment of generalized (immersion) hypothermia begins with artificial respiration, using oxygen if available, Unheated oxygen should not be used for the hypothermia victim, because it will mean added cold; warm, moist oxygen should therefore be administered. An oral airway should be inserted. When respiration is absent or poor, or where there is no detectable carotid pulse, it may be difficult to tell if the patient is dead or alive. If there is uncertainty about the possibility' of life, always try artificial respiration and heart compression. When life-saving measures have been carried out, the patient's wet clothing should be removed and plans made for his immediate and rapid warming. If possible, immersion in a hot bath carefully maintained at 40-42 °C is desirable. If facilities are not available for maintaining a hot bath, hot-water bottles or heating-pads with layers of blankets can be used to warm patients. Great care is needed to avoid burns, to which the cold patient is especially vulnerable. Also, an airway must be maintained if the patient is unconscious.
It is recommended that heat be applied only to the central core of the body. It is of critical importance NOT to attempt to warm the victim's arms or legs since heating of the limbs causes cold blood to flow from them to the body core, causing further detrimental cooling of the core. Such incorrect treatment of hypothermia may induce a condition known as "after-drop".
The patient should be placed in the controlled temperature bath, or other methods of warming should be applied, until the rectal temperature is above 35 °C and he has stopped shivering.
Where there is a large number of cases, first treat those not breathing (but alive) and those who are unconscious. The continuous pouring of water heated to 40-42 °C over those waiting for treatment will increase the number of survivors.
The patient with hypothermia must be observed closely. Depression of breathing and cough reflexes may occur, and secretions may be retained. If a suction unit is available, catheter suction of the airway should be carried out frequently to remove secretions.
Nothing should be given by mouth because the patient may inhale liquid into the lungs, or he may vomit owing to a lack of bowel motility. Alcoholic drinks should not be given until 24 hours after recovery.
It may be necessary to administer intravenous fluids, but this should be done only after getting RADIO MEDICAL ADVICE. If breathing becomes shallow or slow, mouth-to-mouth artificial respiration should be given to support the patient's respiration. In the unconscious patient with hypothermia, the pulse and blood pressure should be checked every 15 minutes and the rectal temperature every half hour. If the patient is comatose or appears to be in shock, RADIO MEDICAL ADVICE should be obtained.
When the patient has been conscious for approximately 12-24 hours, 500 mg of tetracycline hydrochloride should be given by mouth every 6 hours for the next 5 days.
Plans should be made to evacuate the patient from the vessel to the nearest medical facility as soon as possible.
Все темы данного раздела:
Front - Спереди
Frontal region of the head – Лобная часть головы Side of head – Височная часть головы Top of head - Макушка Face – Лицо Cheek - Щека Jaw - Челюсть
Back - Сзади
Back of head - затылок Back of neck – Шея (сзади) Back of shoulder - Плечо Scapula region - Лопатка Elbow - локоть Back upper arm – Верхняя часть
General principles of first aid aboard ship
First aid must be administered immediately to: restore breathing and heart-beat, control bleeding, remove poisons, prevent further injury to the patient (for instance, his removal from a room conta
Если пострадавший в бессознательном состоянии
· Положите пострадавшего на спину и расположите голову так, чтобы подбородок был приподнят;
· Опустите челюсть пострадавшего так, чтобы рот был открыт;
· Убедитесь, что дыхательны
Summary of points to be remembered when applying artificial respiration and heart compression
Don't delay - Place victim on his back on a hard surface.
Step A. Airway - If patient is unconscious, open the airway; thereafter make sure it stays open.
Remember the following expressions
Тщательно составленная история болезни – careful history
Запись в истории болезни – record in a case report
Заполнение истории болезни – filling in a patient’s card
Жалоб
Routine particulars about the ship
1.1. Name of ship
1.2. Call sign
1.3. Date and time (GMT/UTC)
1.4. Course, speed, position
1.5.1. Port of destination is … and is … hours/days away
1.5.
Routine particulars about the ship
1.5. Name of ship
1.6. Call sign
1.7. Date and time (GMT/UTC)
1.8. Course, speed, position
1.5.1. Port of destination is … and is … hours/days away
1.5.
Other comments
Comments by the radio doctor
Make the following radio message Моторист, Н., 45 лет. Приступ сжимающей боли за грудиной, иррадиация в левое плечо
Electrical burns
Make sure you do not become the next casualty when approaching any person who is in contact with electricity. If possible, switch off the current. Otherwise, insulate yourself before approaching an
Treatment
Try to remove patient to hospital within 6 hours, otherwise seek RADIO MEDICAL ADVICE in the case of:
third-degree burns; babies; burns of face and genitalia, and l
Translate the following sentences from Russian into English
1. Ожоги, вызванные сухим и влажным жаром, лечат одинаково.
2. Ожоги первой степени затрагивают только наружный слой кожи, вызывая покраснение, умеренный отек, болезненность при прикоснове
ABDOMINAL PAIN
Minor Abdominal Conditions
This group of conditions includes indigestion, “wind”, flatulence, mild abdominal colic (spasmodic abdominal pain without vomiting or diarrhea and fever),
Appendicitis
Appendicitis is the commonest abdominal emergency, occurring mostly in people under 30 years old, though it can appear in people of any age. When considering appendicitis as a diagnosis, always ask
Indigestion
Indigestion occurs when food fails to undergo the normal changes of digestion in the alimentary canal. It is a symptom and not a disease. Occasional indigestion may be of no consequence, but chroni
Intestinal obstruction
Intestinal obstruction may come on either slowly or suddenly; a common cause is a strangulated hernia. The bowel will always try to push intestinal contents past any obstruction, and as it does so
INFECTIOUS DISEASES
Communicable diseases are those that can be transmitted from one person (or animal) to another. There may be direct or indirect transmission to a well person from an infected person or animal – at
Dysentery
This disease is due to bacteria taken into the system through water or food and usually occurs in tropical and semitropical countries. This bacteria cause severe inflammation of the mucous membrane
Fractures
A fracture is a broken bone. The bone may be broken into two or more pieces or it may have a linear crack. Fractures are described as closed if the skin remains unbroken. If there is a wound at or
Types of fractures
Closed (simple) fracture – закрытый перелом
Combined fracture – сочетанный перелом
Comminuted fracture – оскольчатый перелом
Сompound fracture - открытый перелом
Internal Bleeding
Internal bleeding may result from a direct blow to the body, from strains, and from diseases such as peptic ulcer.
Internal bleeding can be concealed or visible. Bleeding round a broken li
Toxic hazards of chemicals
Ships carry a number of substances in addition to cargo that are potentially toxic. For instance, medicines are not generally poisonous but can become so if taken other than prescribed. Then there
Diagnosis of poisoning
General Principles
The diagnosis of poisoning may be simplified if one of the following factors point to the probable cause:
· the circumstances of the incident, e.g. a lea
Prevention of poisoning
Remember: Prevention is better than cure
Knowledge of the basic safety precautions and strict adherence to them by people working with dangerous goods, and also knowledge
Food-borne diseases (food poisoning)
Food-borne diseases - some forms of which are sometimes also referred to as food poisoning - are illnesses of an infectious or toxic nature caused, or thought to be caused, by the consumption of fo
Less common causes
· Migraine, which usually occurs only on one side of the head and is associated with vomiting and visual disturbances such as flashing lights.
· Brain disease; acute as with meningitis and
Angina pectoris (pain in the chest)
Angina usually affects those of middle age and upwards. The pain varies from patient to patient in frequency of occurrence, type, and severity. It is most often brought on by physical exertion (ang
Specific treatment
Pain can be relieved by sucking (not swallowing) a tablet of glyceryl trinitrate (0.5 mg). The tablet should be allowed to dissolve slowly under the tongue. These tablets can be used as often as ne
Heat-stroke (sunstroke)
Heat-stroke is a medical emergency that is associated with a potentially high mortality rate. It occurs when the body's main mechanism of heat loss (evaporation of sweat) is blocked. There m
Treatment
Immediate treatment must be given to reduce the body temperature, or brain damage and death may occur. The patient should be undressed and placed in a tub of cold (around 20 °C) water; or co
Hernia (rupture)
The abdominal cavity is a large enclosed space lined by a sheet of tissue. The muscles of the abdominal wall resist the varying changes of pressure within the cavity. Increased pressure may force t
Strangulated hernia
Most hernias, whatever their size, manage to pass backwards and forwards through the weakness in the abdominal wall without becoming trapped in the opening. However, the contents of the hernia pouc
High blood pressure (hypertension)
As blood is pumped by the heart, it exerts a pressure on the walls of the arteries. This pressure -blood pressure - varies within normal limits. During activity it tends to be highe
High temperature (hyper pyrexia)
Hyper pyrexia is the word used to describe too high a body temperature, i.e., one of 40 °C or higher. Such temperatures can be dangerous to the survival of the individual and require careful manage
Sore throat
A common complaint, sore throat may be local or it may be part of a serious illness. Tonsillitis (inflammation of the tonsils) and abscesses in the tissues of the tonsillar area are examples of loc
General treatment for sore throats
Take the patient's temperature, and feel for tender enlarged glands in the neck.
Patients with sore throats should not smoke.
For simple tonsillitis or sore throat, gargling with
Peritonsillar abscess (quinsy)
This is an abscess that can follow tonsillitis. It forms normally round one tonsil, and the swelling pushes the tonsil downwards into the mouth. The patient may find it so difficult and painful to
Abandonment of vessel
Lifeboat drills must be conducted to prepare for possible disaster. Both crew and passengers must be instructed in the procedures to be followed. Reasons for such instruction should be given to all
Survivor pick-up by survival craft (lifeboat or raft)
Surviving in a lifeboat or life-craft (hereafter referred to as "the survival craft") is one of the most strenuous ordeals an individual can face. It involves combat against all the eleme
Immediate medical problems aboard survival craft
Trauma
Injuries should be handled as outlined in Chapter 4. However, a prepared medical survival kit might not be available, so the rescuers will have to improvise. The following m
Other medical problems aboard survival craft
Seasickness
Seasickness (motion sickness) is an acute illness characterized by loss of appetite, nausea, dizziness, and vomiting. Preventive measures are often effective.
Medical problems of the rescued castaway on board the rescue vessel
The treatment of survivors will depend on the nature of the rescue facility and the number and medical condition of the survivors.
Personnel on the rescue vessel should rapidly sort all su
Contamination with oil
Do not clean oil off the skin (except round the mouth and eyes) until the person is warm and comfortable. Survivors who have recovered from hypothermia can taken to a warm shower or bathroom and sh
Dehydration and malnutrition
Survivors who have been adrift for several days may be suffering from dehydration. If they have been adrift for several weeks, malnutrition may also be a problem. Caution should be exercised in try
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